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 Episode 193

Perhaps you have seen the article that addresses the recent CDC breastpump cleaning issue?

The CDC has issued new breast pump cleaning guidelines following the life-threatening illness of a preterm infant about 15 months ago. That’s right. You did hear me correctly. I have the article in the show notes so you can read the whole story, however, a baby girl was born prematurely at 29 weeks in April 2016. After 3 weeks in the NICU, she was infected with the Bacteria Cronobacter sakazakii (sock – ah-sock-eee-iii) The investigation showed that samples of the bacteria were traced back to the moms home breast pump as well as her sink and the expressed breastmilk. The incident that is being written up about now, the incident that is causing an uproar in the lactation community, the incident that is quite awful, well this information did not get much play 15 months ago, but now it is being reposted all over various news outlets, and breastfeeding groups and really getting the attention of the public 15 months later. Now, if that is not insane, I don’t know what its. Perhaps the information was out there sooner then this, however, it was not widely known. The question begs – If this is such a major health issue, why is this information taking so long to get out to the public? Why is this information not being shared with every parent who visits their pediatric office?

Actually this information was brought to the publics attention quite a while ago with the document titled: Safe preparation, storage and handling of powdered infant formula Guidelines put out by the World Health Organization, also known as the WHO, in collaboration with the Food and Agriculture Organization of the United Nations in 2007. As early as 2004, there was an interest in concerns regarding bacteria in PIF. This resulted in the WHO 2007 guidelines.

The World Health Assemby – WHA was put to the task of developing guidelines on the safe preparation, handling and storage of PIF Powdered infant formula, in order to minimize the risk to infants. This information is well known to HCP, and yet I do not see such strict teaching given to parents regarding the risks of PIF and the preparation of it. If you have been given instructions to feed your baby formula, has someone sat with you and discussed safe preparation? When parents are unable to provide all their babies human milk needs and I am asked about “which formula is better”, I ask the parents if they have been educated about the formulas, organic vs. non, powdered or ready made by any medical provider they have met with since the birth of their baby. They have been supplementing according to their HCP and yet a very, very, very small percentage of parents tell me that they were given any information other then how much to feed their baby. Most do not remember being told anything about cleanliness and safety, storage guidelines and rarely the difference between powdered or ready made.

Rarely are parents told that powdered infant formula is not a sterile product and may be contaminated with pathogens that can cause serious illness. It is very important that parents be given this information because following these guidelines and correct preparation and handling of PIF reduces the risk of illness.

If you are having a baby soon, If you are not yet involved in the world of breastfeeding and breast pumping, you will be soon. This information is relevant to most people whether they are breastfeeding or not. You may work with or live with or know something who is breastfeeding and you will want to pass this information on to them. This bacteria can be passed on by contaminated infant formula and by contaminated water and poor hygiene. This information is not limited to parents who are breastfeeding and pumping. Because this concerns babies and illness, anyone who is using formula or donor milk will also want this information.

The news came out last week about an infant who contracted the serious, although rare, cronobacter infection. While I do appreciate the public being made aware of this information, I do have a strong opinion about exactly what information is being disseminated and that it is being focused on breastpumping moms and not any adult who is responsible for feeding infants, particularly sick ones and ones under a year of age.

Let’s start with the bacterial infection first. This particularly bacteria cronobacter sock-ahh-sock-ee-ii is a group of germs that can be found naturally in the environment. The germs can live in dry foods, such as powdered infant formula, powdered milk, herbal teas and starches. Health officials have found this bacteria in sewer water.

This is a rare, but serious illness which can affect anyone, however, can be deadly in our most youngest and oldest immunocompromised population, newborns particularly those born prematurely. This is because their ability to fight off infections is lowered, cue to their prematurity or illness or age.

More perspective – The CDC states that they are informed of about 4-6 cases a year. They also state that they may not be informed of all cases as it is not a requirement. Since this is a fairly devastating illness, I am going to guess that HCP would have no reason to not report it and every reason to report it. So, going out on a limb, I imagine that the yearly unreported cases are probably fairly low. Having said that, I do Recognizing that even 1 baby, 1 person who died because of this infection is 1 too many.

I agree with the recommendations from the CDC regarding cleaning pump parts and accessories. The problem that I have is that some things are taken out of context, either by other writers or by moms themselves. What I have seen is a movement to make it seem like the process to follow these guidelines is so much work. It also seems to be bringing out some very real fears for parents about the concern about not cleaning the parts well enough and possibly having infected parts or water or milk pass on to their baby and cause their baby to become ill. These fears are having some parents considering not breastpumping anymore because of heightened fears. This is one of the reasons I am called to do this show… to put things into perspective.

The report states that “the mom reported soaking her breast milk collection kit in soapy water for up to five hours after pumping, without sanitizing or scrubbing. She then rinsed air-dried, and stored the kit in a plastic zip-lock bag until the next use. Samples of the bacteria were traced back to the mother’s home breastpump, the sink, and the expressed milk.”

Pumping is already a lot of hard work for moms who pump on a regular basis. For moms who take their pumps outside the house and pump in places outside their home, this becomes an even greater chore. For them to pay attention to all the new rules provided by the CDC, seems so overhwleming to moms and so much extra work. This has created a situation where myself and other IBCLCs are now receiving questions from parents and with some parents saying that it is just so much work that they are considering switching to formula. the work and the risks are scaring them.

Being a parent is hard work. Pumping when you are away from your baby is super hard work. I have always said that it is like taking on another PT job.
It is not that I mean to say that being a parent, no matter how or what you feed your baby is less difficult than a pumping mom, however, since it does take
quite a bit more work and effort, you will frequently hear me praising moms who have taken on this additional labor of love.

And now this article comes out and the response to it has me very concerned. I am concerned because rather then working towards a solution how you can keep within the guidelines, some parents are ready to give up breastfeeding/pumping I do think it is good for all of us to have the most current information about pump parts cleaning. It is a good reminder to not be in such a rush that we forget to follow the guidelines, or take shortcuts as we know this will reduce the risk of passing on bacterias that can gravely affect babies.

However, I would like to encourage you to keep all this information in perspective.
I am speaking particularly to parents who are seriously considered discontinuing pumping because it is too difficult to take the proper care of their parts and handling of the milk. You are seriously considering switching to formula because it just seems easier and less riskier.

There is no way that I am going to claim to be an expert in cleaning pump parts. There are way too many pumps on the market, with various parts, for me to begin stating on this podcast what the proper guidelines are. I have links in the show notes that will give you – the latest WHO guidelines, as well as the latest CDC guidelines and the recent story that highlighted this serious issue. I have also listed a link

Here is what I would like parents to know:

1. We all do the best we can with the information that we have at the time. When we know better, we do better.
2. We have been advised of the latest guidelines for pumping and handling and storing of your milk and these guidelines should be followed.
3. Don’t be fooled into thinking formula feeding your baby is going to be any less time consuming or with less risk.
4. Every single health organization from the WHO to the AAP to the AABM to The CDC states that breastfeeding is one of the best things you can do for your baby’s health and benefits include preventing many kinds of infections.

The last things our health organizations want you to do is take away the exact food that is going to give your baby the most health benefits, because you are afraid of your baby contracting this particular bacterial strain, which again has affected only 4-6 known cases and the babies were premature or ill. The CDC reported very few cases of cronobacter infections among infants who were fed only human milk and nor formula or other foods.

While it’s important to follow the CDC recommendations as best as possible, it’s also worth recognizing that the benefits of providing an infant with breast milk far outweigh the risks associated with inadequate pump cleaning. As an IBCLC, I have observed many poor quality pumping conditions than I would care to speak about. I have seen moms wash parts and then put them on the sink counter in their hospital rooms. I have seen moms wash pump parts, put it on a clean countertop and watched cats walk across the counter touching the parts. As a pump rental station, I have actually been sickened by the way pumps have come back into my possession. Animal hairs on the pumps, tomato sauce, milk spots, makeup on the pump. I have seen mothers change their babies diapers and do a very quick wash of their hands before pumping. I do my due diligence and when the situation warrants it, I gently discuss proper safety guidelines. However, I know that most people have their own habits, their own way of doing things and by and large, the babies are okay and not being sickened by rare infections.

As I have said, when it comes to formula, the liquid formula is much more expensive than powdered formula and powdered formula comes with a well known risk of germs. The CDC states to use Liquid formula whenever possible because of this risk.

The problem that occurs is that because of the greater expense of liquid formula, more parents use powdered formula and this puts their babies at greater risk. Also, the use of powdered formula comes with strict guidelines that take up as much time and care that it will take a pumping a fair amount of time, to be sure everything is handled with the utmost of care as far as cleaning, sanitizing and storing. So, this choice is not only not without risk, the risks are greater than a mom who is pumping and providing her own milk for her baby, largely because of all the protective factors in her milk, that are not in formula.

There is lots of handwashing involved. Warming water, being sure to cool formula before feeding to baby, I often see parents running the bottle under cool water with the cap off. The instructions for preparing powdered formula safely included capping the bottle, to keep the cool water from getting onto the bottle or on the nipple as germs can be transferred to baby this way.

Another major problem that puts babies at risk is that I also see lots of parents not wanting to waste formula, so they do 2 things. One is to encourage baby to drink it all up, even if the baby is giving them signs they are done. I see t his happen with breastmilk also. I can appreciate not wanting to waste, however, this ignores the babies cues that are letting you know that he or she is done feeding. They are full. I also see parents leaving the formula on the counter and using it 2 or more hours later. Germs multiply very fast and this is not recommended.

These guidelines need to be followed by anyone who is preparing the formula as well as anyone who is heating up and cooling the bottles. I have been around enough daycare providers to see these guidelines being ignored.

I am mentioning some of the guidelines involved with PIF just so you have some perspective on this subject.
Please don’t stop pumping your milk for your baby, just because the workload is too much.

One tip for pumping moms that I would like to share:

Perhaps you might consider doubling or tripling up on the accessory parts so this could reduce time spent worrying about cleaning parts correctly. Yes, it is an expense, however, it is a worthy expense for your childs safety. Perhaps at the end of the day, you can assign the pump parts cleaning task to another adult in the household. They may not be able to pump and provide the milk that you can, but they can take on the task of parts washing, storage and preparing bottles for day care and packing it up for you. When you have another adult in the house, don’t take this all on yourself – share the workload.

Again, trying to put this into perspective, let’s talk car seats.

We hate having to spend so much money on car seats. They cost a lot of money and they are a bit of a pain to put your kids in. You may even be purchasing multiple car seats for family members and grandparents. Studies show though, that you can have the most expensive car seat, with the best ratings, however, if it is misused, not placed properly in the car, belts not adjusted according to what your baby is wearing, if your baby is over the maximum weight – all of these oopsies cause the safety factor of this very expensive car seat to go down and the risk factor to increase. Using it properly and following all the manufacturers instructions, making sure other adults are using it correctly, is time consuming, but we do it for the safety of our kiddos. Think of the extra time we take in other instances to make our environment safe for our children. When it comes to your pump and your pumping habits, put it in the same category of needing to be mindful for safety reasons. Another tip: You may know what you are doing? However, have you discussed this with other family members or daycare providers who will be feeding your baby and handling their food?

Having a baby is tons of work. Making sure they are well fed is a lot of work. Paying attention to safety guidelines, no matter what you are feeding your baby, is also a lot of work. However, all the major health organizations agree that human milk is species specific and that if at all possible, human babies should receive human milk for the first year of their life.

I know it is a lot of work for some moms to keep up with the pumping and following all the storage guidelines. The first year of life, truly does go so fast. Most of us feel that if flies by. I know when you are in the thick of it all and the responsibility lies with you to take care of all this, that it is hard. I just want you to know that know matter what you feed your baby, there are risks involved and the fact remains that breastfeeding your baby, your milk is the least riskiest of them all and providing your baby with your pumped milk, is the least riskiest of all and is not any less time consuming then preparing powdered formula is.

As you contemplate your response to this article, I would like to highlight a few points:

1. This was a single isolated incident of a tragedy that happened with a premature, baby, who was infected with a bacteria that actually could have come from several sources.
2. What is not mentioned and what I do not know for sure, is that this baby was more than likely being fed formula, which is often commonly recommended for premature babies. these formula are usually powdered formulas.
3. This bacteria was found in the sink and could be in the water. Water that was used to clean the parts. Water that was used to mix with the powdered formula.

Working moms who are breastfeeding and pumping while away from their babies, already have it hard enough. Many moms need to pump in places where they will not be able to follow the strict guidelines set forth by the CDC These strict guidelines many cause some to stop pumping and providing their milk.

Given the above mentioned bullet points, I want you to keep in mind that if you have a healthy, full term baby, particularly a few months or older, the benefits of continued pumping far outweigh the risks and the likelihood of your baby being the less than 5 babies infected with this bacteria is quite rare. So, I beg you to please keep this in mind. You may look at these guidelines and panic because you are already struggling to find the time needed and the space needed to pump appropriately. You have figured out a way to make it work.” Recognize these strict guidelines are a quick reaction, which is based on fear. My fear is that untold babies will miss out on the benefits of human milk and mom will miss out on the health benefits to them also. because you are driven by fear and not good common sense and education. I hope I have provided you with another way of looking at this issue and that I helped to put things into perspective for you.

I will leave you with today’s quote in honor of all the moms listening to this show today that even spent one little baby second striving to be the perfect mother.

“There is no way to be a perfect mother but a million ways to be a good one.”

http://www.who.int/foodsafety/publications/micro/pif_guidelines.pdf

Infant Illness Causes CDC to Issue Breast Pump Cleaning Guidelines

https://www.cdc.gov/features/cronobacter/index.html

https://www.breastfeedingincombatboots.com/2017/07/new-breast-pump-cleaning-guidelines-what-ad-moms-need-know/

Lori J. Isenstadt, IBCLC
Lori j Isenstadt, IBCLCLori Jill Isenstadt, IBCLC is a huge breastfeeding supporter.  She has spent much  of her adult life working in the maternal health field. Once she became turned on to birth and became a childbirth educator, there was no stopping her love of working with families during their childbearing years.  Lori became a Birth doula and a Postpartum doula and soon became a lactation consultant.  She has been helping moms and babies with breastfeeding for over 25 years.  Lori founded her private practice, All About Breastfeeding where she meets with moms one on one to help solve their breastfeeding challenges.  She is an international speaker, book author and the host of the  popular itunes podcast, All About Breastfeeding, the place where the girls hang out.  You can reach Lori by email at: [email protected] or contact her via her website:  allaboutbreastfeeding.biz/contact

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